The Good Doctor S02E02
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00:00you're here early trouble sleeping no just wanted to get out of my apartment and to work
00:13work you plenty hard enough go home making sure you're rested is also part of the job
00:18i understand
00:19what should i tell a patient if they don't think they're sick but i think they have
00:26pancreatic cancer you think one of our patients has pancreatic cancer
00:3017 he's burnt 17 times in 10 minutes it's a frequent symptom of pancreatic cancer
00:44sean acid reflux he's also jaundiced
00:50no he isn't paul's skin is definitely not the same color it was six months ago
01:00paul i looked at his mouth when he was telling me about his daughter
01:04she just walk with me
01:05say nothing
01:08hey sean
01:28do a cbc cmp amylase lipase ca19 ion levels and ct abdomen tell this pancreatic protocol and do not tell him why
01:41you want me to lie
01:42i don't want you to tell the truth
01:44the discoloration if there is any is very minor
01:47i don't want you scaring the crap out of the man over nothing
01:48excellent i've been practicing lying
01:51i lied to you before when i said i just wanted to get out of my apartment and to work
01:55take clear
01:57hello i'm dr limb how can i help you today asha
02:06i want plastic surgery
02:10sweetheart this is the emergency room
02:13if you want i can make an appointment for you
02:15you do vaginal rejuvenation right
02:17yes
02:19on much older much veiner women generally after having many children
02:23i don't know what the boys have told you
02:26examine me
02:27please
02:29please take off your underwear
02:32were you in an accident
02:58no
02:59can you help me
03:02did your father do this to you
03:05no please just
03:06did your mother
03:06i need to know who did this to you
03:08no you don't
03:09it doesn't matter who
03:10when i was two years old
03:19i was tied down and i was circumcised
03:25please
03:29i'm hideous
03:32will you help me
03:38yes
03:42why do you need to confirm a diagnosis of acid reflux
03:59because we're doctors
04:00it's what we do we just like to be sure everything
04:03there are a few remote possibilities
04:08i've got this
04:09are you familiar with the hospital employee manual section 17 subsection c triple i
04:17no
04:17good
04:18good
04:19yes
04:19it requires that
04:22all employees shall be subject to
04:25and i quote
04:26any and all possible necessary tests to confirm any and all diagnoses
04:31no matter how mundane the cost of which tests shall be borne by the hospital
04:34end quote
04:35the board wants to make sure that no one is exposed to patients if there is any chance
04:48that they have any communicable condition
04:50i had the flu last week
04:58why didn't anybody do anything for me then
05:01it's a new policy
05:05you might have pancreatic cancer
05:06what
05:08what do you say
05:10female genital mutilation is the ritual cutting or removal of some or all of the external female genitalia
05:18over 200 million victims worldwide
05:21it is almost universally practiced in a number of african and asian countries
05:26where was she born
05:27wisconsin
05:28yeah it's way more common here than you think
05:31what religion is she
05:32i didn't ask
05:33this isn't about religion
05:34no legit religious organization endorses this stuff
05:37we're gonna do the labiaplasty first thing in the morning
05:39the damage done to her nerves is not going to get undone
05:42nor is the psych damage
05:43but at least she'll look like other girls
05:46we should be able to have her out of here by six in the evening
05:48outpatient
05:49why the hurry
05:50so her mother will simply think she's in school then out studying with her friends
05:54she loves her parents and doesn't want to tell them that she's rejecting one of their cultural traditions
06:01they won't stay in the dark for long since we're legally obligated to report them
06:04that cultural tradition also fits the definition of abuse
06:08and they'll also find out when we ask for their permission to do this surgery
06:11she's a minor
06:12her id says she's 18
06:14yes her fake id says she's 18
06:17her number starts with an h which means she was born in the 50s
06:20also the photo background is green instead of blue
06:22also six other things
06:24maybe we can get legal to get a court order
06:26if i believe that id is real
06:28then i'm entitled to perform this surgery
06:30without seeking consent of anyone other than the patient
06:33and as legally required within 36 hours
06:36i will report the evidence of abuse under the name and address listed on that id
06:40if the investigation of that report doesn't begin until the girl is long gone
06:46and happens to lead nowhere because the name wasn't real
06:49that's no fault of mine
06:50are you sure you want to risk your medical license to protect an abusive mother
06:54if we do this by the book
06:55we never see that girl again and no one gets helped
06:58if we do this by the book
06:59maybe the cops lock the parents up
07:01we shine a light on this thing
07:02our community gets scared
07:03and maybe the next girl doesn't need our help
07:05or maybe the testimony of the girl about what happened to her when she was two
07:09doesn't help the cops at all
07:10maybe the parents just take their daughter home
07:13and maybe we scare the next girl into not even asking for help
07:16i'm doing the surgery
07:19to this girl
07:20under this name tomorrow morning at 7 a.m
07:24i can't believe people ever lie
07:37there are so many questions people might ask you
07:42but if you tell the truth you already know the answers
07:46also it's wrong
07:49but sometimes you shouldn't tell the whole truth
07:54no of course not
07:57because that lets you be honorable
08:00and tell the truth and be a good person
08:03but at the same time you get to completely deceive the person
08:07no i don't think
08:09leah came back
08:10wow sean that's great
08:13she's staying with me until she finds her own place
08:16you must be so excited
08:18yes
08:20you're not excited
08:24i said yes
08:26paul has one year to live
08:32he has pancreatic cancer
08:35stage three
08:37there are no metastatic lesions but there are local nodes involved
08:45there's partial encasement of the superior misentery artery
08:48that puts it past the point where we can cure with local resection
08:50we could do whipple surgery
08:53that's not advised for stage three pancreatic cancer
08:56not quite
08:56it's not advised for stage four
08:58for stage three it's discretionary
09:00in my discretion
09:02he's better off with 12 semi-comfortable months
09:04rather than running the risk of dying on the table tomorrow
09:06if he doesn't die on the table
09:08he could have many years
09:09it isn't our call to make
09:11i'll talk to paul
09:12advise him of the parameters
09:13let him make his own decision
09:15no
09:17sean should do it
09:20clara can do it
09:23yes she can
09:23which is why you should do it
09:25this is a teaching hospital
09:26andrews is right
09:28being a surgeon isn't just about cutting
09:30would it be okay if we spoke someplace more quiet
09:43you need someplace quiet to tell me i have acid reflux
09:59i think we should be someplace quiet because people sometimes get very upset when they find out they probably only have less than a year to live
10:10okay uh can i call my family
10:20they should probably hear what you have to say too
10:23i'd rather just talk
10:24of course you can
10:25i'll elevate it with a six inch chambler tissue hook you separate the underlying tissue with iris forcep
10:32i got it it's anatomy scissors
10:34i think we're actually a little ahead of schedule
10:37we might be able to get her home in time to do her homework
10:39back to the bosom of her loving family
10:41we'd remove as much of the cancer as possible by removing the head of the pancreas and other attached organs but then we'd have to reconstruct the anatomy
10:53the easiest way to do that is to bring up a loop of jejunum
10:56mishan
10:57sorry
10:59the jejunum is part of the small intestine between the duodenum and ilium
11:04it's complicated
11:07very dangerous surgery
11:08and even if it's successful post-operative complications are frequent and serious
11:13and recovery can be very painful
11:15but if it works he's better
11:18he'll be healthy
11:19he would still need chemotherapy
11:21and a lifetime of monitoring
11:23but
11:24hopefully a long lifetime
11:26let's do it dad
11:29what do you say
11:31what should i do
11:35it's your decision
11:39all we can do is present you with the facts
11:43yeah here are the facts
11:47dad
11:48the surgery may kill you
11:50not doing the surgery will kill you
11:59can you give us a few minutes
12:04of course
12:05it was very nice of dr andrews to give you an office even though you're on medical leave
12:18yeah he is a prince
12:19who's your surgeon going to be
12:21i haven't
12:22i haven't decided yet
12:24you should definitely go with dr joshua atkinson at stamford medical center
12:31his mortality index is 0.3
12:33it's too low
12:34not enough of his patients are dying
12:37no sean sometimes patients die
12:39doesn't matter how good the doctor is
12:40but when your mortality rate is as low as atkinson's
12:43it means you're turning away patients
12:45you turn away patients
12:46it means you lack confidence
12:47you lack confidence
12:48i don't want you inside my head
12:50and i'd like to be able to address myself
12:53when i'm all done
12:54sean what are you doing here
12:58you showed up at work early this morning
13:01go home
13:03get some rest
13:04i won't rest if i go home
13:09the surgery went great
13:19once everything's healed
13:21i think you'll be very happy with the results
13:23what time is it
13:25not quite 5 45
13:26we just need you to pee and
13:28i need to go home
13:30and you will
13:30very soon
13:32it hurts
13:35i told you it would
13:36we did a lot of cutting and scraping
13:38you had a lot of scar tissue
13:40it hurts a lot
13:41we'll give you some tylenol
13:43and you can tell your mother you're cramping
13:44pain ketamine 130 micrograms per kilogram per hour
13:51why does it hurt this much
13:55i don't know
13:56they're not going home
13:59no
14:00she's heavily sedated
14:06what do we do to her
14:08what if this is good news
14:09i know you haven't been a doctor all that long
14:13but pain is rarely a sign of good news
14:15it is if you're talking about a part of the body you thought was dead
14:18what if this means there's still viable nerve endings in there
14:21what if this means we can actually reconstruct her clitoris
14:24and that it's capable of sensation
14:25maybe
14:26all we know for sure
14:28she's not going to be home anywhere near six
14:30which means we're about to have a missing child on our hands
14:32you have to bring andrews up to speed
14:35i did a bad job
14:50of telling you that you're dying
14:52is there a good way
14:57i can't figure out when i'm supposed to lie
15:02when i'm supposed to tell part of the truth
15:05and it doesn't really matter
15:06because i can't figure out how to do it anyway
15:09you did fine with me
15:14you never need to lie
15:16lies don't predict you from the truth
15:19i don't like your haircut
15:23okay
15:27maybe sometimes when the truth can't help someone
15:34we should definitely just lie
15:39do you think praying will help you reach a decision
15:45i've already reached a decision
15:49i'm praying to help me find comfort
15:53with that decision
15:54my family wants surgery
15:57and what do you want
16:02i want what my family wants
16:06i love them
16:08but they love you too right
16:10don't they want what you want
16:14long ago i made a decision
16:19to be there for them
16:22no matter what
16:25and if the last choice i make
16:30in my life
16:31is consistent with that
16:33i'm comfortable with that
16:39i was surprised by you
16:57i arguably made errors in judgment but it was all in an effort to help a patient
17:01yes and that would make sense if you thought you'd never have another patient ever again
17:05and if there wasn't currently an opening for chief of surgery
17:08i didn't know that was on the table
17:10see that's the difference between you and melendez
17:12i have no doubt that as soon as i got this promotion melendez had done the math
17:18and reacted accordingly
17:19but i suspect that even if you had done the math
17:22it wouldn't have changed how you handled this patient
17:25i don't view that as a weakness
17:27i'll handle the administrative fallout
17:32you
17:32notify the parents immediately
17:35i can't
17:39we don't know the girl's real name
17:40and we have to keep her sedated
17:41so there's no way we can track
17:43she's a teenager she's got a phone
17:44next time it rings
17:46answer it
17:47feel the mesenteric artery pulsing
17:55yes
17:56you shouldn't
17:56you're too close to the vein
17:57great
17:58dr brown
17:59pass the penrose drain through
18:00lovey
18:04suction
18:09not at all
18:20i
18:23see leaking pancreatic fluid
18:25i don't need holes in everything it touches
18:27our ductile didn't hold
18:28suction
18:28funeral driver
18:29excellent
18:32you have approved a scrub nurse
18:35and a circulating nurse
18:36and seven other personnel
18:37everyone and everything is covered
18:39except for an actual surgeon
18:40yeah
18:41i think we may have to postpone
18:42have you notified your tumor
18:44to stop growing in the interim
18:45i think
18:45any possible damage from a delay
18:47may be more than offset
18:48by having somebody competent
18:50digging around in my brain
18:51competent
18:52what's wrong with sanders
18:54six percent mortality rate
18:55taylor
18:56i don't like the way he's planning on
18:57dealing with a carotid tear
18:58that's nowhere near your tumor
19:00it's the principal
19:01unger
19:01he doesn't like me
19:02no one likes you
19:03no you don't like me
19:04he doesn't like me
19:05that's two
19:06just pick a name
19:06i don't care who
19:07i don't care if they're a doctor
19:08just pick a name
19:10because in 48 hours
19:11you're either getting your surgery
19:12or you're getting a new oncologist
19:14she's in pain
19:27that's why she's asleep right now
19:30because of what you did to her
19:32what i did to her
19:36i believe revealed that what you did to her
19:40didn't do as much damage as we initially feared
19:43we want to do a second surgery
19:45how can you stop our pain
19:46it's called clitoral reconstruction
19:48the nerves of her clitoris are exposed
19:50we can sheath them
19:52our daughter wants this
19:53asha wants to be like other girls
19:56she wants to be able to
19:58mother told you that
20:00that's our doctor's name
20:03that's asha
20:05you don't know her at all
20:08we need to do this surgery
20:10to relieve her pain
20:11no
20:12there must be another way
20:14we want a second opinion
20:16not that it's hospital
20:17how soon can our daughter be moved
20:20excuse me dr. Lim
20:21i'm ellen vatra
20:22from child protective services
20:24until i complete my review
20:26i'm afraid you're not going to be
20:27moving your daughter anywhere
20:28how did it go
20:39is that okay
20:40there were complications
20:44but we found solutions
20:47it went very well
20:49we got it all
20:50oh my god
20:54there's still
20:55i don't think i did that well
21:00they're too happy
21:01post-surgical complications
21:03are still a major concern
21:05let them enjoy the good news
21:06is deceiving someone in a way
21:08that makes them happy
21:09better than deceiving someone
21:11in a way that makes them sad
21:12sean
21:13i think there's someone here to see you
21:16hey
21:17i had some time
21:19so i thought you might want to have some lunch with me
21:22i do not have time
21:26what's wrong
21:41what did she do
21:43sean
21:44you don't want to talk to leah
21:52i don't understand
21:54i don't understand
21:55i don't understand
21:57you're not being fair to her or yourself
22:00she's always been nice to you
22:01no she hasn't
22:02she's your friend
22:05whatever's happened
22:06you have to talk to her about it
22:07be honest about what you're feeling
22:08i can't be
22:09of course you can
22:11i don't know
22:13i don't know
22:14i don't know how i feel
22:16i can't be honest if i don't know how i feel
22:22our 16 year old daughter is lying in a hospital bed unconscious to protect her from overwhelming pain because of what this place did to her
22:37without our permission
22:39and you are investigating us
22:41your daughter is suffering because you butchered her when she was two years old
22:45dr lim please refrain from unsubstantiated allegations
22:47either they're the butchers or they're protecting the butchers
22:50if you didn't do it tell us who did
22:52it was an aunt and a grandmother from kenya
22:59they were watching mara while we were on vacation
23:02well you must have been horrified
23:04did you take her to a doctor
23:06that girl's sex organs were covered with scar tissue
23:09she had no medical attention to treat any of her wounds
23:12she was fine
23:13she was happy
23:14laughing
23:15it's not that big a deal
23:17i was cut
23:24my mother was cut
23:26her mother was cut
23:27it is a rite of passage connecting our women to their ancestors
23:31she will not find a husband in our culture if she's not
23:34she'll find someone else
23:34it's not that big a deal
23:37these parents forfeited the right to make any calls about their daughter a long time ago
23:41our daughter is an honor student taking three ap classes in her junior year
23:47went on a mission to haiti to build a school
23:49we have raised her well
23:51she's a good person
23:53we're proud of her
23:56i'm sure she's a good person
24:00you're not going to convince me that what happened to mara when she was two years old is anything short of an abomination
24:06but that's not the issue today
24:08the issue is how do we best help this girl now
24:12the clitoral reconstruction should protect the exposed nerve
24:16should
24:16that is the surgery that in my medical opinion is called for
24:21but it's not the only option
24:22we could ablate the peripheral nerves and remove the remaining clitoral tissue
24:28and is that surgery safer or more dangerous
24:31it's simpler but that's not the only factor here
24:33it's the only factor to us
24:35we want to know that our daughter won't spend the rest of her life in pain
24:40please
24:42for a moment
24:43can we think about something other than mara's pain
24:46can we think about her pleasure
24:49we have a chance
24:51to give her a healthy meaningful sex life
24:55that is what she came here looking for
24:57wake her up
25:04she's in pain
25:05and she's already told me what she wanted
25:07yesterday she was requesting cosmetic surgery
25:09today you're asking her to risk a lifetime of pain for a chance at pleasure
25:13from everything i've heard
25:15she's mature enough to make the call herself
25:16even if it means suffering for a few minutes to do so
25:19dr unger has a mortality index that is not too high and not too low
25:29it's not going to be unger
25:30you have not eliminated dr co
25:33not yet
25:34i may have to go out of state to find a neurosurgeon
25:38plus i may have to find myself a new oncologist
25:41you've used dr co many times
25:44did you think she might kill your patients
25:46no
25:47do you think you're better than them
25:50yes
25:50a little
25:51that was a joke
25:56you don't want to talk about this
25:59no i don't want to talk about this sean
26:01that in fact is the point of the alcohol
26:04okay i understand
26:07good
26:08why can't we talk about it
26:18because it's upsetting
26:20is that why you're stalling
26:22because you're afraid of dying
26:24i'm not afraid of dying
26:26really
26:27why not
26:29you should be
26:31dying is terrible
26:32yes dying is terrible
26:34but there are worse things
26:36what's worse than dying
26:39not dying
26:44that doesn't make sense
26:48it makes sense to me
26:49that doesn't make sense
26:52it's the middle ground sean
26:54brain surgeries have a tendency to end in the middle ground
26:59brain surgeries can be considered a success
27:03even when the patient ends up compromised
27:06he can't walk
27:07he can't talk
27:07his hand can't stop shaking
27:10i've been terrible at a lot of things in my life
27:16but i am damn smart
27:18and i am a damn good surgeon
27:22and if i can't be those things
27:25then i don't know
27:26who i'd be
27:27you'd be my friend
27:35well thank you sean
27:45i have to go
27:56my patient just crashed
27:57it's not enough
28:04it's not enough
28:04is it
28:06no
28:11i'm sorry it isn't
28:14mom
28:27mom
28:27dad
28:28we're here
28:30i love you
28:32we just don't understand why you would turn your back
28:35hello
28:36mara
28:37i'm ellen vatra
28:38i'm a social worker
28:39your parents know what happened
28:41and dr limb gave you a nerve block
28:43it hurts
28:44it still hurts
28:46i understand that
28:47and we are going to try to get you back to sleep as quickly as possible
28:49but something happened during your surgery
28:51and we need you to make a decision about what is done next
28:54we believe that despite what was done to you as a child
29:01the reason you're in so much pain is because you still have functioning nerves in your clitoris
29:05nerves that had been covered with scar tissue
29:07i'd like to repair that
29:09we can make you physiologically complete
29:12but there's no guarantee that will work
29:14i'm confident
29:17there is a safer choice
29:20we could
29:24remove your entire clitoris
29:27this is your choice
29:29you will be protected no matter what
29:32take it out
29:37mara
29:38we can make you whole
29:39i made a mistake
29:40take it out
29:41she's on medication
29:42she's in pain
29:43dr limb please let her go back to sleep
29:45and prepare to operate to remove the damaged tissue
29:48hey fresh frozen plasma too
30:01it looks like he's going into dic
30:02give me another chemostat
30:03bp 71 over 53
30:05we should have warned the family
30:07i don't see anything in here
30:08there's too much blood
30:09more suction
30:09i think you got a hepatic artery
30:10the warning wouldn't have made any difference
30:12bleeding is not slowing down
30:13we need to send the aorta to the celiac
30:15we need to see it to clamp it
30:16they would have been prepared
30:18hey lines the solid 54 is bottoming out
30:20no they wouldn't
30:21you two shut up and pack his abdomen with laps
30:23while i sort through this mess
30:24i won't do it
30:26can we appeal this do you know
30:28i've spoken with our legal department
30:29unless we can prove the social worker was biased
30:31we are stuck with this ruling
30:33well then you're also stuck with
30:34i won't do it
30:35you're a good doctor
30:37this hospital will miss you
30:38you're gonna fire me because i won't butcher a teenage girl
30:41of course i am
30:42this hospital will face lawsuits suspensions
30:44perhaps criminal charges
30:45and this little girl will still get the surgery you hate
30:48could dr. Lim at least talk to Mara again
30:55you want to wake her up again in pain
30:58every woman deserves the right
31:00to make decisions about her sexuality
31:02without her parents hanging over her
31:03when i was 15 years old
31:33my father caught me with a boy
31:35i mean we weren't
31:36doing it but
31:38my top was off and
31:40well it doesn't matter
31:41my father hit me
31:44i still have a small scar
31:46our relationship was never the same
31:50but that's what growing up is
31:52not everyone gets
31:53called a slut
31:54not everyone gets
31:56butchered
31:57but everyone becomes a man
32:00or woman
32:01and stops being a child
32:02i want to take a piece of tissue
32:06from inside your cheek
32:07and i want to graft it to your clitoris
32:10we can make you feel
32:14love
32:15i can't turn my back on my family
32:27on my traditions
32:28traditions
32:32connect us to the past
32:34what about the future
32:37please
32:47no
32:48i'm in pain
32:49cross-clamping his aorta
33:04he's in ventricular fibrillation
33:06starting chest compressions
33:09okay
33:15everybody clear
33:16prep the cheek as well
33:40she's taking the graft
33:43the paperwork doesn't say
33:45i sent it verbally
33:45i didn't want to keep her awake
33:47any longer than absolutely necessary
33:48i wanted to help her as much as you
33:52when she wanted help
33:53but if she doesn't want this
33:55she wants this
33:56dr lynn just told us
33:58prep the cheek
34:15i'll tell the family
34:19no
34:21claire you do it
34:23this isn't the time for learning
34:25i'm sorry
34:39paul died during surgery
34:43paul died during surgery
34:55he had a gastro duodenal artery rupture
34:59it's a common complication of a whipple surgery
35:02especially when someone's cancer was as advanced as his was
35:06we did everything we could for as long as we could
35:11he didn't suffer
35:13you did this to him
35:20dad didn't want this
35:24you saw that look on his face
35:27he was scared
35:27in my experience
35:29it does no good to dwell
35:32of course
35:32he was scared
35:33that doesn't mean that he
35:34he just wanted to live his last few months
35:36stop it
35:36nobody made your father do anything
35:39he knew the risks
35:41it's your fault too mom
35:45all of us
35:48you would do anything for us
35:51we killed our father
35:55it's not true
36:04paul wanted this surgery
36:11he told me he wanted this surgery
36:16oh my god
36:30oh my god
36:32oh my god
36:37oh my god
36:42oh my god
36:43Is that true?
36:53Paul told me
36:54when the truth can't help someone
36:58we should lie.
37:10Mom?
37:13How are you?
37:16Does anything hurt?
37:18Not much.
37:20Better.
37:23Looks like she's doing well.
37:26Thank you, doctor.
37:29There should still be some discomfort
37:31at the surgical site.
37:33A nurse will bring you some.
37:42Sorry.
37:42A nurse will bring you some Tylenol,
37:45which should really be all you need.
37:52You're gonna be great.
37:57You're here.
38:09I live here.
38:21You know that.
38:22Well, I was starting to doubt it the last couple of days.
38:25You come home after I'm asleep.
38:28You leave before I can even get up.
38:31Wow.
38:43Please take this.
38:46No, this is yours, Sean.
38:48I gave it to you to remember me by.
38:50It hurt.
38:51It hurt.
38:55I didn't want to tell you the truth because I didn't know it,
38:59but I have to tell you the truth because it will help.
39:02Every night I would come home and I would look at that baseball and I would think of you.
39:19The baseball was here, but you weren't.
39:23That's sweet.
39:24No, it isn't.
39:28It hurt.
39:29You hurt me.
39:31Okay, Sean, you know.
39:33You went away and it hurt and it kept hurting and now you're back.
39:41If you stay, you will go away again and it will hurt again.
39:46So I want you to go back to Hershey.
39:49I know you don't mean that, but I know that it's angry.
39:53Please go back to Hershey or anywhere other than here.
40:19Feeling okay?
40:29Yeah, sure.
40:30Super duper.
40:32I want to thank you for your trust.
40:35I'll do my best to deserve it.
40:37Well, that's all I can ask.
40:42You know the drill.
40:49I'll do my best to deserve it.